<p> UNIVERSITY GRANTS COMMISSION </p><p>FORM OF APPLICATION ______</p><p>POST: ………………………………………………………… (Indicate the name of the post as given in the advertisement) ______</p><p>01. (a) Name with initials :</p><p>(b) Names denoted by Initials :</p><p>------02. Whether Rev./Mr./Mrs./Miss : ------03. (a) Postal Address : </p><p>(Any change should be communicated immediately)</p><p>(b) Contact Telephone No. : </p><p>(c) E-mail Address :</p><p>------04. National Identity Card No. :</p><p>------05. (a) Date of Birth : Year Month Date</p><p>(b) Age as at the closing date Years Months Days of applications : ------06. Civil Status : ------07. Whether Citizen of Sri Lanka : (State whether by decent or by - 2 -</p><p> registration) if by registration, give reference number & date of certificate of citizenship </p><p>Contd…/2</p><p>------8. Race : (State whether Sinhala, Tamil, person of Indian Origin or Muslim) ------09. Education : From To Schools Attended Year Month Date Year Month Date 1. 2. 3. 4. 5. ------10. Qualifications- (All qualifications to be considered should be indicated in the application)</p><p>(a) University Education: (Attach copies of certificates & transcripts) Date of Effective Class Duration Degrees/Diplomas University Commencement Date Yea Mont Mont Date Year Date r h h 1.</p><p>2.</p><p>3.</p><p>4.</p><p>(b) Professional Qualifications: (Attach copies of certificates)</p><p>Date of Effective Qualifications Institution Commencement Date Duration Obtained Ye Mont Mont Date Year Date ar h h - 3 -</p><p>1.</p><p>2.</p><p>3.</p><p>4.</p><p>5.</p><p>Contd…/3</p><p>(C) Postgraduate Qualifications. (Attach copies of certificates) Date of Effective Duration Postgraduate Commencement Date (Prescribed University By Course or Degree/Diploma period of By Research Yea Mont Yea Da Date Month Registration r h r te 1.</p><p>2.</p><p>3.</p><p>4.</p><p>5.</p><p>(d) Training/Workshops attended: (Attach copies of certificates) </p><p>Name of the Training From To Institution Programme/Workshop Duration Yea Month Date Year Month Date r</p><p>1.</p><p>2.</p><p>3.</p><p>4. - 4 -</p><p>5.</p><p>------11. Any other academic distinctions scholarships, medals, prizes etc.: (indicate the Institution from which such awards have been obtained) (Attach copies of certificates)</p><p>Contd…/4 ------12. Research & Publications if any : (If space is insufficient, please use separate sheet of same size)</p><p>------13. Highest examination passed in : Sinhala/Tamil ------14. (a) Present Occupation : 13 14 1. Post :</p><p>2. Date of appointment to such post :</p><p>3. Whether confirmed in the present post :</p><p>4. Place of work with the Address :</p><p>5. Salary Scale of the post :</p><p>6. Present Salary a. Basic Salary : </p><p> b. Allowances :</p><p>(b) Previous appointments if any, with dates: (Attach copies of service certificates) Reason for Department/ Period of Service Salary From To Cessation of Post Institution Scale Employment Year Month Date Year Month Date - 5 -</p><p>------15. (a) Period of experience gained as at the closing date of Applications relevant to the post applied : Years Months Days</p><p>Contd…/5 (b) If you have obtained no-pay leave during this period, state reasons and the period of such leave :</p><p>------16. Extra Curricular activities : (If space is insufficient, please use separate sheet of same size)</p><p>Event Achievements Level</p><p>Sports </p><p>Subject Level</p><p>Other Certificates</p><p>Positions held in Positions Professional Body/Society//Organization - 6 -</p><p>Professional Body/Societies/ Organizations/etc.</p><p>Achievements</p><p>______17. (Names of two non related referees with addresses and Contact Nos. ) </p><p>Name Designation Address Contact No: Email Address 1.</p><p>2.</p><p>I do hereby certify that particulars submitted by me in this application are true and accurate. I am aware that if any of these particulars are found to be false or inaccurate, I am liable to be disqualified before selection and to be dismissed without any compensation if the inaccuracy is detected after appointment .</p><p>Date: ………………….. ……………………………….. Signature of Applicant ------Secretary, University Grants Commission. - 7 -</p><p>Application is recommended and forwarded. I certify that the particulars given in numbers 01 to 14 of this application are correct according to the applicant’s personnel file and if he / she is selected for the said post he / she can be / cannot be released.</p><p>………………………………..</p><p>Signature of the Head of the Governing Body & Official Stamp</p><p>------Remarks if any :</p><p>------Date:</p>